Provider Demographics
NPI:1336020460
Name:GOMEZ, JARED T (CSW)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:T
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 E SOUTH TEMPLE STE 250
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1273
Mailing Address - Country:US
Mailing Address - Phone:385-258-9121
Mailing Address - Fax:
Practice Address - Street 1:275 E SOUTH TEMPLE STE 250
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84111-1273
Practice Address - Country:US
Practice Address - Phone:385-258-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health